Healthcare Provider Details

I. General information

NPI: 1033264122
Provider Name (Legal Business Name): OFELIA OFRECIO MARISTELA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CAMPUS DR SUITE 210
DALY CITY CA
94015-4900
US

IV. Provider business mailing address

92 BRIGHTON CT
DALY CITY CA
94015-2848
US

V. Phone/Fax

Practice location:
  • Phone: 650-994-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA32383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: